Burns

Question 1

Tell me about the different depths of burns?

Answer 1

SUPERFICIAL aka first degree - epidermis (erythema only). Can be differentiated from partial thickness by rubbing the skin. If the epidermis moves around, sliding over the deeper layers, this is a partial thickness burn.

PARTIAL THICKNESS aka second degree - affects the dermal layers. Can be sub-divided into superficial dermal, mid dermal and deep dermal.

FULL THICKNESS aka third degree - all the way through the dermis and may also affect deeper tissues.

Question 2

Calculating burns area?

Answer 2

Total Body Surface Area

• only include partial and full thickness areas
• Wallace RULE OF NINES (head 9%, torso 18%, back 18%, each arm 9%, each leg, 18%, perineum 1%
• Smaller scattered burn use PALMAR METHOD (palm hand and fingers is 0.8% of TBSA, 1% in paeds)
• used for calculating fluid requirements

Question 3

Burns fluid requirements?

Answer 3

• lots of oedema leads to hypovolaemic shock
• MODIFIED PARKLAND FORMULA is used
• give if TBSA burned is >15% adults or >10% in children
• other factors may lower fluid threshold eg other injuries or ihalational burns
• Hartmanns is fluid of choice
• first half of fluid should be given in the first 8 hours after the burn (not after the presentation)
• second half should be given over the next 16 hours

- FORMULA =
4mls x (TBSAburn%) x weight

Question 4

3 important factors in a burns history?

Answer 4

• time at which burns occurred
• duration of expose (helps assess depth)
• enclosed area? (inhalation injury)

Question 5

Burns first aid?

Answer 5

• try to remove jewellery and clothing as appropriate (if clothing is stuck to burn leave it alone)
• dressing varies on policy
• run under cool water, for 20 minutes if <3hrs since burn (beware of large burn this may cause hypothermia)

Question 6

Specialist burn management?

Answer 6

If TBSA burned >10% adult or 5% children the consider transfer to burnets unit.
Other factors for transfer:
- very young
- very old
- pregnant
- other comorbities / trauma
- chemical burns
- circumferential burns

Question 7

Causes of pathology in inhalational injury?

Answer 7

Inhalational injury occurs in 20% of burns patients; 60% of facial burns; major cause of mortality.

Causes:

• thermal injury to airway
• chemical injury to airway
• systemic effects from toxins (CO, cyanide - from some plastics and wools)
• hypoxia / asphyxia from fires O2 consumption

Question 8

Signs of airway injury

Answer 8

Upper airway:

• singed nostrils / nostril hairs
• singed eyebrows
• soot in nose
• change in voice / hoarseness
• STRIDOR

Lower airway:

• wheeze
• SOB
• pulmonary oedema